Gainswave Eligibility Quiz

Welcome to GAINSWave Eligibility Quiz!

We are about to ask you a few simple questions to find out if GAINSWave® is right for you.

We value your privacy and your desire to know if this therapy is appropriate for your individual sexual wellness goals. The answers you provide will be collected but not shared outside our office and authorized GAINSWave® medical providers.

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What is your age?

25 - 34

35 - 50

51 - 65

65+

None

How's your sex life?

Amazing

Can't complain

Could be better

Nonexistent

None

How's your ability to get and maintain erections?

Excellent

Good

Fair

Low

Can't ever get it up

None

Do you have a medical condition or take medications that affect sexual performance?

Yes

Don't know

Prefer not to answer at this time

None

Have you tried other treatments for Erectile Dysfunction (ED)?

Yes

None

Did other Erectile Dysfunction (ED) treatments work?

Yes

Worked somewhat

Didn't work

None

How would improving your ability to get and maintain erections affect your life?

It would be life changing

It would improve my life a lot

It would make my life a little more fulfilling

It wouldn't change anything

None

If you knew there was a treatment that could significantly improve your ability to get and maintain erections, how motivated would you be to follow through with it?

Very motivated!

I'd try my best.

I'd give it a try but I have little trust.

If I see the results right away, I might continue.

Not very motivated. Just looking around.

None

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You are done! To ensure privacy, we'll send you results via email.

Your First Name

Your Email

Phone

I agree to receive the results of this evaluation and other communication from CT Hormone Therapy and Integrative MD via email.

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